Ischemia times and donor serum creatinine in relation to renal graft failure
- 1 March 2003
- journal article
- research article
- Published by Wolters Kluwer Health in Transplantation
- Vol. 75 (6) , 799-804
- https://doi.org/10.1097/01.tp.0000056632.00848.8d
Abstract
Background. The results of renal transplantation are dependent on many variables. To simplify the decision process related to a kidney offer, the authors wondered which variables had the most important influence on the graft failure risk. Methods. All transplant patients (n=1,124) between January 1981 and July 2000 were included in the analysis (2.6% had missing values). The variables included were donor and recipient age and gender, recipient original disease, race, donor origin, current smoking, cardiovascular disease, body weight, peak and current panel reactive antibody (PRA), number of preceding transplants, type and duration of renal replacement therapy, and time since failure of native kidneys. Also, human leukocyte antigen (HLA) identity or not, first and second warm and cold ischemia times, left or right kidney and fossa, donor kidney anatomy, donor serum creatinine and proteinuria, and transplantation year were included. Results. In a multivariate model, cold ischemia time and its time-dependent variable significantly influenced the graft failure risk censored for death (P P <0.0001). The risk of a high donor serum creatinine is already enlarged in the immediate postoperative phase and increases thereafter; the curve is closely related to the degree of the elevation. The other variables with a significant influence on the graft failure rate were, in order of decreasing significance, recipient age, donor gender, donor age, HLA identity, transplantation year, preceding transplantations, donor origin, and peak PRA. Conclusions. Donor serum creatinine and cold ischemia time are important time-dependent variables independently influencing the risk of graft failure censored for death. The best strategy for improving the results of cadaveric transplantations is to decrease the cold ischemia time and to allocate kidneys from donors with an elevated serum creatinine to low-risk recipients.Keywords
This publication has 27 references indexed in Scilit:
- EFFECT OF HISTOLOGICAL DAMAGE ON LONG-TERM KIDNEY TRANSPLANT OUTCOMETransplantation, 2001
- PERMANENT DETRIMENTAL EFFECT OF NONIMMUNOLOGICAL FACTORS ON LONG-TERM RENAL GRAFT SURVIVALTransplantation, 2000
- RELATIONSHIP OF RECIPIENT AGE AND DEVELOPMENT OF CHRONIC ALLOGRAFT FAILURETransplantation, 2000
- OUTCOME OF KIDNEY TRANSPLANTATION FROM HIGH-RISK DONORS IS DETERMINED BY BOTH STRUCTURE AND FUNCTIONTransplantation, 1999
- IMPORTANCE OF MINIMIZING HLA-DR MISMATCH AND COLD PRESERVATION TIME IN CADAVERIC RENAL TRANSPLANTATIONTransplantation, 1996
- High Survival Rates of Kidney Transplants from Spousal and Living Unrelated DonorsNew England Journal of Medicine, 1995
- Cold Ischemia And Outcome In 17,937 Cadaveric Kidney TransplantsTransplantation, 1995
- The Impact of HLA Mismatches on the Survival of First Cadaveric Kidney TransplantsNew England Journal of Medicine, 1994
- PROGNOSTIC INDICES TO PREDICT SURVIVAL OF FIRST AND SECOND RENAL ALLOGRAFTSTransplantation, 1991
- An Alternative Approach for Statistical Analysis of Kidney Transplant Data: Multivariate Analysis of Single-Center ExperienceAmerican Journal of Kidney Diseases, 1988